Lack of proper immunisation along with managerial issues, environmental factors and natural disasters are behind the increased number of polio cases in Sindh since the past five months, said Dr Yehia Mostafa, World Health Organisation’s (WHO) polio eradication team leader in Sindh.

Talking to The News at his office, he said, “When there are polio cases, it means that children are susceptible to the infection by the virus, because they are not immunised. The children may be vulnerable to the virus because they have been vaccinated but not immunised or their vaccination was not effective.” There are basically two reasons related to vaccination and environmental conditions, along with some other reasons behind the appearance of polio cases, he stated. According to him, several parents refuse to vaccinate their children because they do not believe in a routine immunisation and some parents have their own perspectives regarding polio. If their child or infant is sick, they consider that he/she should not be vaccinated which is not true, he added.

Furthermore, some parents do not believe in vaccines provided by the teams either because the team members are young or because of their ‘improper appearance’, while some think that routine vaccinations are enough and refuse to vaccinate their children during campaigns. Although polio vaccine is safe and several dozes of drops do not contain any side effects, Mostafa elaborated.

“Lately in my country (Egypt) and in India, it was proven that in order to possess a good immune system, a child should at least have eight dozes in the first year of his/her life,” Mostafa expressed. According to him, it is widely observed that on an average, six to four doses or even less are administered to children in Sindh in their first year of life.

Regarding environmental factors, he said that because of contaminated water/food, several different viruses are competing with the polio vaccine virus, which might decrease the effect of the vaccine. When a child is receiving the vaccine while suffering from diarrhoea or vomiting, vaccine efficacy will be decreased so we need to repeat the vaccination, he explained.

In the process of vaccination, a lot of children are not immunised because their teams are not able to reach them or the houses are missed or the children are sleeping or playing outside the house, he said. Due to weak supervision by the area in-charges or zone in-charges children are not vaccinated in the prescribed period of time, he further informed. Natural disasters such as the recent floods in the Interior Sindh also compound the problem because the people often relocate.

Discussing the nine polio cases in Sindh since the last five months, Mostafa said that most of the children were either not vaccinated, or were partially routinely vaccinated. He added that there was only one child among the nine children who had undergone a full routine vaccination. “That child probably did not possess a suitable level of immunity in the body,” he mentioned. The same virus infected a girl in North Karachi who travelled to SITE Town and infected another child, he added.

Meanwhile, Mostafa informed that there are two types of virus named, ‘A-3-A’, which surfaced in Karachi and then travelled to Ghotki, Hyderabad and Mirpurkhas and came back to the city. The other type is ‘A-3-D’, which was detected in Kamber last year and moved to Nawabshah, Naushehroferoz, Shikarpur and Jacobabad districts through family relations or neighbours.

To a question about discontinuing drops against P-1 polio for a considerable period of time as now almost all the cases belong to this category, he answered, “We usually move according to an epidemiological situation.” He said if P-1 cases are decreased, hence they focus on preventing P-3 cases. About the efficacy of the management of routine vaccination and campaign, Mostafa quoting his teacher said that polio cases surface in “a state of war or a state of mismanagement.”

Moreover, he said that many rounds of the campaigns have ‘defects’ and not a single round is a 100 per cent or even 90 per cent satisfactory. The coverage is also not homogenous and some areas are left out. “We can eradicate this virus only through tree to four good rounds, if each and every child is vaccinated,” he elaborated.

“I am afraid that surfacing of the polio cases might lead to the fatigue factor,” he apprehended. Quoting the example of his country Egypt, he said that it also carried out many rounds for 10 years but could not control polio. He added that when the Egyptian government finally took it seriously in 2002 the polio virus was controlled within one and a half years. The reason was “a good selection of polio teams, area in-charges, close supervision of them, good training of teams, ownership of government and community, accountability of everyone and high level of community awareness, “ he told The News.

As for treatment facilities for the polio cases, Mostafa stated that they have started collecting the data from the disabled people in Sindh recently to interpret “how exactly can we help them.” He said around three million dollars are spent on every polio campaign in the country without counting the vaccine cost, which is provided by the Pakistani government.